The Importance of Ethics in Clinical Practice Part 3
Confidentiality
Therapists are required to preserve confidentiality and to disclose, if requested, the limits of confidentiality and circumstances under which it might be broken to specific third parties. It should be borne in mind that therapists have a duty to the community at large as well as to individual clients.
Any stated limitations to confidentiality may produce communication barriers, however, complete confidentiality cannot be promised.
Therapists must be aware of what confidentiality can be offered and must work towards maintaining this level to provide the client with safety and privacy. The client should be told of the limitations to confidentiality at the start of the therapy.
Audio/visual recordings or observation of the session by anyone other than the therapist should not be allowed without the client’s permission.
All personal client information such as name, address, details of the client’s life, etc., which could identify the client, whether they are obtained directly, indirectly or by inference, must be treated in confidence. Using reference numbers on client files and a system to identify clients’ names by cross-referencing, stored separately, would maintain confidentiality in the event of unauthorised persons gaining access to the main files.
Sometimes exceptional circumstances arise when confidentiality cannot be maintained. This may include serious physical harm to the client or a third party. In such circumstances the therapist should attempt to get the client to agree to allow the release of the information to relevant parties. It is only polite to seek permission even if the therapist has initially contracted with the client that they would break confidentiality in the event of someone possibly sustaining serious injury. In this event, as in all others concerning breaching confidentiality, the therapist should discuss the matter with either their supervisor, the NSHP&M and/or the NCHP.
Accidentally meeting clients outside the therapy room is a problem for some. The client might not want whomever they are with to know they are seeing a therapist. It is easier for all concerned if the therapist tells the client that, should they meet outside the therapeutic setting, the therapist will not acknowledge the client unless the client acknowledges them first.
Confidentiality should be maintained even after the client’s death.
Confidentiality and the Legal System
A therapist is not obliged to give information regarding their client to the police, a solicitor or a lawyer unless ordered to do so by a court. However, there are exceptions to this. If the offence relates to the prevention of terrorism you are obliged to give the requested information to the police without a subpoena or court order. In the event of hearing of terrorist activities, the therapist should immediately contact either their supervisor, NSHP&M or take legal advice.
Various statutory provisions require information to be divulged. In the UK, this includes statutes relating to notifiable diseases, notification of drug addiction and notification of venereal diseases (excluding AIDS). Disclosure of notifiable diseases should usually be made to the client’s GP (even without the client’s consent) who is under a statutory duty to report the information to the Community Medical Officer (Stone J, 2002, 174)
Under a circuit judge’s warrant, police have the right to seize confidential files. In such circumstances, obstructing a police officer in their duty could be an offence. The most useful course of action is to ask the police officer to state their legal right to an answer before either answering or refusing to give one. Lying could be an offence.
If summoned to appear at court under a subpoena, attendance is obligatory. A request to appear at court for any parties involved in a case need not be complied with. All witnesses once in the witness box are obliged to answer questions when instructed to do so by the court. Failure to answer the questions could be deemed as contempt of court, with the possibility of punishment by imprisonment.
The exception to this is in certain matrimonial cases, during an attempt at reconciliation, the communications between therapist and client are deemed privileged and need not be disclosed without the client’s permission. Any notes used during work with a client may be used as evidence in court if so ordered. Any therapist who is contacted by the police or any other legal body should seek clarification about procedures from the legal helpline operated via the NSHP&M. Â
